Gaps in care prove painful

By Christian Livermore

Monday

Jul 28, 2008 at 2:00 AM

MONTGOMERY — Andrew Pacini was on unemployment when he learned he had pancreatic cancer. At the time, he had health insurance through his previous employer, but two months ago it ran out, leaving him no coverage for his chemotherapy, medication and other needs.

MONTGOMERY — Andrew Pacini was on unemployment when he learned he had pancreatic cancer.At the time, he had health insurance through his previous employer, but two months ago it ran out, leaving him no coverage for his chemotherapy, medication and other needs.He applied for Medicaid, but was told he didn’t qualify.On July 20, he found himself unable to breathe. He was admitted to the hospital, which took over the responsibility of trying to find him insurance.That hospitalization may have gotten Pacini the coverage he needs.But many languish for years with a disease for which they are not being treated, or may not even know they have.Only pain remainsPacini, 56, was diagnosed with pancreatic cancer last July. He had been out of work for several months because of a blood clot.As cancers go, pancreatic is one of the worst you can get. According to the National Cancer Institute, in 2008, some 37,680 people will be diagnosed with the disease; 34,290 will die.Very quickly, the distractions the Bronx transplant loved – baseball, bowling – disappeared, and his life became all about the cancer.Chemotherapy, pills, doctors, pain. Such pain.When asked about hobbies he hopes to pursue again, Pacini just laughed.“I don’t have no hobbies no more,” Pacini said. “I’m just trying to get through the day.”In June, Pacini’s COBRA – extension of insurance through a previous employer – expired, and he was turned down for Medicaid. His income of $1,530 a month, combined with wife Rhonda’s $800, and the home they own, made him ineligible.“I’m saying to (the Medicaid worker), ‘I have no coverage, I need medications, I need breathing apparatus. You’re putting a death sentence on me,’” Pacini said.His chemotherapy halted, the pills went away.Few local optionsSome 47 million Americans lack health insurance, according to the U.S. Census Bureau.In Orange County, many of them turn to the Department of Social Services for help.So far this year, the department has processed 6,578 Medicaid applications. In January, 996 applications were made; 244 were denied.You don’t have to make much to be ineligible for Medicaid: $13,300 for a family of four, like Pacini’s, will rule you out.“It is not a high threshold,” said Commissioner David Jolly. “If you think about it, there has to be some kind of threshold for the program, but sometimes it creates situations like this.”Many of the uninsured wind up in local hospitals. Orange Regional Medical Center, for instance, where Pacini was admitted, treated 6,100 uninsured inpatients in 2007, and lost $1.5 million on uncompensated care. Such losses frequently lead hospitals to lay off employees and cut services. Two weeks ago, Bon Secours Charity Health System cut 80 jobs in the Hudson Valley, citing uncompensated care as a big reason.A human price tagIn some ways, Pacini is one of the lucky ones. Or at least one of the less unlucky ones.The catastrophic nature of his disease means he will probably get treatment. A much bigger hole in the health-care system is in such illnesses as diabetes, hypertension and high cholesterol, said Dr. Jeffrey Buckner, a medical oncologist in New York City.Because these diseases lack urgency, uninsured people often don’t get preventive care and screening tests. They get sick more, and die sooner. More than 25 people die per week in New York – about 1,300 in 2006 – because of a lack of health insurance coverage, according to the national health-care consumer advocacy group Families USA.“In the end, people who don’t get decent medical care suffer the consequences, whether it’s heart attack or stroke or amputations or other complications from diabetes,” Buckner said. “That’s where the societal and human cost is going to be paid.”It all comes down to moneyAn incident early in his career seared in Buckner’s memory the competing possibilities and shortcomings of the health-care system.During his first Saturday night on call at Bellevue Hospital, an alcoholic with severe liver disease was being treated in the intensive care unit. As often happens with the disease, the blood vessels in the patient’s esophagus had burst, and he was vomiting huge amounts of blood. Doctors and nurses surrounded his bed, setting up IVs and other treatments, hoping he’d survive.“And in the midst of all this,” said Buckner, “I remember the guy said, ‘How am I going to pay for this?’”clivermore@th-record.com

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